Medicine an Surgery notes

PEPTIC ULCER TREATMENTAIMTo relieve painTo heal the ulcerTo prevent ulcer diathesisRelevant pathophysiology;Peptic ulceration is the result of an imbalance between aggressive and protective factors in the upper gastrointestinal tract.The principle aggressive factors are gastric acid and pepsin.The two most important factors disrupting the balance are;1) Helicobacter pylori; Causes direct damage of the gastric mucosa and also stimulates increase in gastrin release hence increased acid secretion. 2) Non-steroidal anti-inflammatory drugs (NSAIDs);Impair mucosal resistance. They do not alter acid secretion,Drugs used in the treatment of peptic ulcer;1) Antacids2) Drugs that inhibit acid secretion;H2-receptor antagonistsProton pump inhibitorsSynthetic prostaglandin analogues3) Drugs that do not directly inhibit gastric acid secretion;Chelate salts of bismuthSucralfate4) Drug combinations used to eradicate H. pylori ANTACIDS Mechanism of ActionThese drugs are weak alkalis, so they partly neutralize free acid in the stomach.They may also stimulate mucosal repair around ulcers, possibly by stimulating local prostaglandin release.PharmacokineticsMost antacids (principally salts of magnesium or aluminium) are not absorbed from the alimentary tract to any appreciable extent. Some, such as sodium bicarbonate are absorbed.Adverse effectsAntacids that contain aluminium tend to cause constipation, whereas those containing magnesium tend to cause diarrh